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Progestogen Therapy: Effects, Uses and Side Effects

Progestogen therapy is a hormonal treatment using progestogens (corpus luteum hormones), applied in gynaecology, contraception, and hormone replacement therapy.

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Things worth knowing about "Progestogen therapy"

Progestogen therapy is a hormonal treatment using progestogens (corpus luteum hormones), applied in gynaecology, contraception, and hormone replacement therapy.

What is Progestogen Therapy?

Progestogen therapy refers to the medical use of progestogens – a group of hormones that structurally or functionally resemble progesterone, the naturally occurring corpus luteum hormone produced in the female body. Progestogens may be natural (e.g., micronised progesterone) or synthetic (known as progestins). They are central to many areas of gynaecology and are a key component of hormone replacement therapy.

Mechanism of Action

Progestogens bind to specific progesterone receptors in various body tissues, triggering a wide range of biological responses. Key effects include:

Suppression of ovulation through negative feedback on the pituitary gland and hypothalamus
Thickening of cervical mucus, which impedes sperm from entering the uterus
Inhibition of endometrial proliferation, creating a secretory phase unsuitable for implantation
Support and maintenance of early pregnancy during the luteal phase
Anti-oestrogenic (antiproliferative) effect on the endometrium

Indications

Contraception

In contraception, progestogens are used both in combination with oestrogens (combined hormonal contraceptives such as the combined oral contraceptive pill) and as standalone agents. Progestogen-only preparations include the mini-pill, progestogen injections (e.g., depot medroxyprogesterone acetate), hormonal implants, and hormonal intrauterine devices (levonorgestrel IUS).

Hormone Replacement Therapy (HRT)

During the menopause, progestogens are combined with oestrogens in hormone replacement therapy to reduce the risk of endometrial hyperplasia (abnormal thickening of the uterine lining) and associated endometrial cancer. Women who have had a hysterectomy generally do not require progestogens.

Gynaecological Conditions

Progestogen therapy is used in the management of various gynaecological conditions, including:

Endometriosis: Progestogens suppress the growth of endometriotic lesions and alleviate pelvic pain.
Uterine fibroids (myomas): Certain progestogens may help relieve associated symptoms.
Dysfunctional uterine bleeding: Irregular or heavy menstrual bleeding can be regulated with progestogens.
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD)
Luteal phase deficiency: Luteal phase support, particularly in assisted reproductive technology (ART).

Oncology

High-dose progestogens (e.g., megestrol acetate, medroxyprogesterone acetate) are used in oncology for the treatment of certain hormone-sensitive cancers, particularly endometrial carcinoma and in some settings breast cancer, as well as for cancer-related cachexia (loss of appetite and weight loss in cancer patients).

Dosage Forms and Administration

Progestogens are available in a variety of formulations:

Oral: Tablets (e.g., mini-pill, oral progesterone capsules)
Transdermal: Patches or gels in combination with oestrogens
Vaginal: Suppositories, capsules, or gels (especially micronised progesterone)
Intrauterine: Hormonal coils (e.g., containing levonorgestrel)
Subcutaneous / intramuscular: Implants or injections

Dosage depends on the indication, the specific progestogen used, and the individual needs of the patient. The appropriate regimen should always be determined by a qualified healthcare professional.

Side Effects

Like all hormone therapies, progestogen therapy may cause side effects. Commonly reported side effects include:

Mood changes and depressive episodes
Weight gain
Breast tenderness
Changes in bleeding patterns (spotting, absent periods)
Changes in libido
Acne and oily skin (particularly with androgenic progestogens)
Headaches

More serious risks, particularly with long-term use or in combination with oestrogens, may include an increased risk of thromboembolic events and, in certain circumstances, a slightly elevated breast cancer risk. Individual risk should always be assessed by a healthcare professional.

Contraindications

Progestogens should not be used, or used only with careful medical consideration, in the following situations:

Known or suspected hormone-dependent tumours
Unexplained vaginal bleeding
Severe liver disease
History of thromboembolic events (depending on the specific preparation)
Known hypersensitivity to the active substance

References

Strowitzki, T. et al. – Progestogens in Gynaecology. Gynecological Endocrinology, Springer, 2020.
World Health Organization (WHO) – Medical Eligibility Criteria for Contraceptive Use, 5th Edition, 2015. Available at: https://www.who.int
Beral, V. et al. – Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies. The Lancet, 1997. Available at: https://www.thelancet.com

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